Introduction Botox is a purified toxin made from a bacterium. As such this is a toxic product but its use has been standardised in a variety of disorders in medicine as well as in certain urological conditions. Botulinum toxin described herein is an attempt to affect the muscles in your bladder in order to help your urinary symptoms.

History Botox has been used in various muscle spasm disorders and in plastic surgery. The first scientific medical use was in the 1960s and it was subsequently approved for use in the United States in 1989. The first European approval was granted in 1992.

Urinary disorders Botox has been successful in treating a variety of bladder and urinary continence disorders. These include overactive bladder, multiple sclerosis, spinal cord injury with neuropathic bladder, stroke, interstitial cystitis, urinary retention and certain forms of prostatism. In each of these conditions it is realised that the over activity of affected muscles cause the symptoms which lead to symptoms. Botox produces a temporary paralysis of the injected muscles, improving and sometimes resolving the symptoms all together.

Botox injection into the bladder muscles Your overactive bladder will produce symptoms of urinary frequency, urgency and urge incontinence. You may have tried alternative treatment in the form of medication and behavioural treatment in the form of bladder training which has not helped you. You must try these treatments before undergoing Botox injection to the bladder. In your condition the Botox is injected into the bladder muscle wall in several specific locations. The published reports indicate great success with minimal or no side effects. Most people will find that urgency and urge incontinence are resolved or greatly improved.

Duration of benefits The maximum relief of symptoms with Botox is usually seen 7 days after the injection and normally lasts between 6-10 months. You may need repeat injection if your symptoms recur.

How is the Botox injected Injection of Botox into the bladder is a minimally invasive procedure and can be performed as a day case procedure. This can be done under local as well as under general anaesthetic using a cystoscope. The Botox is injected into 20- 30 sites in your bladder.

Side effects The use of Botox is very safe. Very rarely, however, there are minor side effects. Occasionally headache, light-headedness, fever, abdominal pain and diarrhea may occur. Many of the side effects are not necessarily a direct result of Botox. Rarely patients may experience flu like symptoms and may need to be looked after as an inpatient in the hospital. There have been no deaths reported.

Because the injection has a paralyzing effect on the muscle of the bladder there is a small chance that you will experience problems in emptying your bladder. This seems to occur in about 4% of patients and lasts for about six weeks. If this happens we shall have to teach you the technique of intermittent self catheterisation in order to empty you bladder until you are able to do this unaided.

Long-term side effects of repeat injections With one or two injections the situation is often greatly improved but repeated injections may be needed in some patients. This is the only area where there is to date not enough experience to comment with confidence the need for future injections. Our knowledge on side-effects of long-term repeated use is also limited, but Botox has been used for at least the past 20 years in other situations of muscle injection and at least 4-5 years in urological disorders where no specific side effects have been encountered.

Summary A recent review of 100 patients with overactive bladder treated with Botox injections has been published.
Overall after 4 and 12 weeks 88% of patients demonstrated significant improvement in bladder function wrt to subjective symptoms, quality of life and urodynamic measures. Urgency disappeared in 82% of the patients and incontinence resolved in 86% within 1 to 2 weeks after injection. Mean frequency decreased from 14 to 7 micturitions daily (-50%) and night time voiding decreased from 4 to 1.5 micturitions. Mean maximal bladder capacity increased 56% from 246 to 381 ml. Only 8 patients failed to derive clinical benefit.

Important points
The use of Botox in this context is experimental but there is increasing data supporting its efficacy. Botulinum Toxin A is not licensed for this indication in the United Kingdom and therefore has to prescribed on what is called a “Named patient” basis as an exception because of the refractory nature of your current symptoms to conventional treatments. Therefore your treatment is not as an experimental procedure but as an exceptional therapeutic process.

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